204 unit 3 | Professional Issues
Burnout
Definition
The ultimate result of unmediated job stress is
burnout. The term burnoutbecame a favorite buzz-
word of the 1980s and continues to be part of
today’s vocabulary. Herbert Freudenberger formal-
ly identified it as a leadership concern in 1974. The
literature on job stress and burnout continues to
grow as new books, articles, workshops, and videos
appear regularly. A useful definition of burnout is
the “progressive deterioration in work and other
performance resulting from increasing difficulties
in coping with high and continuing levels of job-
related stress and professional frustration” (Paine,
1984, p. 1).
More than 20 years of research on nursing work
environments point to personal, job, and organiza-
tional factors that contribute to dissatisfaction and
ultimately burnout (McLennan, 2005). Ultimately,
nurse burnout affects patients’ satisfaction with
their nursing care. A survey of 820 nurses and
621 patients in 20 hospitals across the United
States (Vahey et al., 2004) showed that units char-
acterized by nurses as having adequate staff, good
administrative support for nursing care, and good
relations between physicians and nurses were twice
as likely as other units to report high satisfaction
with nursing care. The level of nurse burnout on
these units also affected patient satisfaction.
Much of the burnout experienced by nurses has
been attributed to the frustration that arises because
care cannot be delivered in the ideal manner nurses
learned in school. For those whose greatest satisfac-
tion comes from caring for patients, anything that
interferes with providing the highest quality care
causes work stress and feelings of failure.
People who expect to derive a sense of signifi-
cance from their work enter their professions with
high hopes and motivation and relate to their
work as a calling. When they feel that they have
failed, that their work is meaningless, that they
make no difference in the world, they start feeling
helpless and hopeless and eventually burn out
(Pines, 2004, p. 67).
The often unrealistic and sometimes sexist
image of nurses in the media adds to this frustra-
tion. Neither the school ideal nor the media image
is realistic, but either may make nurses feel dissat-
isfied with themselves and their jobs, keeping stress
levels high (Corley et al., 1994; Fielding & Weaver,
1994; Grant, 1993; Hendrickson, Knickman, &
Finkler, 1994; Kovner-Malkin, 1993; Nakata &
Saylor, 1994; Pines, 2004; Skubak, Earls, & Botos,
1994).
Sharon had wanted to be a nurse for as long as she
could remember. She married early, had three chil-
dren, and put her dreams of being a nurse on hold.
Now her children are grown, and she f inally real-
ized her dream by graduating last year from the
local community college with a nursing degree.
However, she has been overwhelmed at work, criti-
cal of coworkers and patients, and argumentative
with supervisors. She is having diff iculty adapting
to the restructuring changes at her hospital and goes
home angry and frustrated every day. She cannot
stop working for f inancial reasons but is seriously
thinking of quitting nursing and taking some
computer classes. “I’m tired of dealing with people.
Maybe machines will be more friendly and
predictable.” Sharon is experiencing burnout.Aspects
Goliszek (1992) identified four stages of the
burnout syndrome:1.High expectations and idealism.At the first
stage, the individual is enthusiastic, dedicated,
and committed to the job and exhibits a high
energy level and a positive attitude.
2.Pessimism and early job dissatisfaction.In the
second stage, frustration, disillusionment, or
boredom with the job develops, and the indi-
vidual begins to exhibit the physical and psy-
chological symptoms of stress.
3.Withdrawal and isolation.As the individual
moves into the third stage, anger, hostility, and
negativism are exhibited. The physical and psy-
chological stress symptoms worsen. Through
stage three, simple changes in job goals, attitudes,
and behaviors may reverse the burnout process.
4.Irreversible detachment and loss of interest.
As the physical and emotional stress symptoms
become severe, the individual exhibits low self-
esteem, chronic absenteeism, cynicism, and
total negativism. Once the individual has
moved into this stage and remains there for any
length of time, burnout is inevitable.Regardless of the cause, experiencing burnout
leaves an individual emotionally and physically
exhausted.